Managing COPD to improve quality of life

The mortality rate for chronic obstructive pulmonary disease (COPD) has increased significantly in recent years. Although smoking cessation is still the most important intervention in COPD, a variety of pharmacologic therapies are available to help manage symptoms. Short-acting β₂-agonists and/or ipratropium can be prescribed, with the use of additional therapies based on the severity of disease. Persons with moderate or severe COPD should regularly take 1 or more long-acting bronchodilators. The long-acting β₂-agonists salmeterol and formoterol have been demonstrated to improve health-related quality of life. Newer therapies include the long-acting anticholinergic tiotropium and a salmeterol/fluticasone combination. These agents improve forced expiratory volume in 1 second and may reduce the rate of acute exacerbations. For patients with moderate to very severe COPD, participation in a pulmonary rehabilitation program can improve health status, quality of life, and exercise tolerance.